Type 2 Diabetes: Weight Loss Surgery Better Than Lifestyle Changes?

A new study strongly suggests that weight loss surgery might be better than even lifestyle changes in combating type 2 diabetes. The study, which was published in the JAMA Surgery journal, is small, but many of the people involved in it who had weight loss surgery showed significant improvements in their diabetes symptoms in comparison to people who tried to combat their diabetes through lifestyle changes, alone, even three years following the surgery.

The University of Pittsburgh Medical Center’s Dr. Anita Courcoulas was the lead researcher of the study, which followed 61 people with type 2 diabetes between the ages of 25 to 55. About half had class 1 obesity, in which the body mass index (BMI) was between 30 and 39. BMI is the measure of a person’s weight in relation to his or her height.

Roughly half the group of 61 followed an intensive lifestyle intervention for one year. During the year, they were aided in their weight loss regimen through behavior changes, exercise, and dieting. Over the next two years, this group participated in a lower-intensity lifestyle intervention. This involved taking part in behavioral counseling a few times a month.

The rest of the group were heavier people who had either Roux-en-Y gastric bypass (RYGB), or laparoscopic adjustable gastric banding (LAGB) weight loss surgery performed on them. The surgery was followed by taking part in the same sort of lower-intensity lifestyle intervention that the first group also took part in. Dr. Courcoulas was impressed by the “durability of remission over time,” that she noted in the group of people with type 2 diabetes who had the surgery.

The researchers who wrote and published the latest study are cautiously optimistic about the results. That is because the study was small and, although past studies have also shown that sometimes weight loss surgery has helped to improve the symptoms of people with type 2 diabetes, further research and studies need to be done to conclusively prove that weight loss surgery is better at treating the disease than lifestyle interventions.

Generally speaking, weight loss surgery is only performed on people who have a BMI of 40 or higher, or in cases where a person has a lower BMI but also has other health issues. That is the main reason why there is not as much information about the potential benefits of weight reduction surgery for people who have class 1 obesity.

The Centers for Disease Control and Prevention reports that around 29 million Americans have diabetes. that is roughly 9 percent of the entire population of the United States. The most common form of diabetes, type 2, is more often found in people who are obese compared to the rest of the population.

People who have type 2 diabetes fall into two groups. With some people who have it, their bodies do not produce enough of the hormone insulin for their cells to use to convert glucose to fuel. In the cases of other people who have type 2 diabetes, their bodies produce enough insulin but for some reason, their cells are resistant to it.

Type 2 diabetes, the most common form, is often linked to obesity. In type 2 diabetes, either the body does not make enough insulin or enough insulin is produced, but the cells of a person’s body are resistant to it. Insulin helps cells use glucose for fuel.

The results of the study were that no one in the lifestyle intervention group had shown even a partial remission of their type 2 diabetes. In comparison, in the LAGB group 29 percent of the people had at least a partial remission while in the RYGB group, 40 percent had a partial remission.

What is even more encouraging, one person in the LAGB group and three people in the RYGB group had no further signs or symptoms of having type 2 diabetes. This did not happen for anybody in the group that only took part in lifestyle intervention.

An added benefit was that compared to the lifestyle intervention group, the two groups that had weight loss surgery showed an improvement in blood sugar control. Some people in the surgery groups also no longer needed medication to control their type 2 diabetes.

Dr. Courcoulas stated that “the next step,” will be to follow up the study and “see what the remissions look like at five and seven years.” Though the study was a randomized study, the kind often thought to be the “gold standard” of medical research, the data will be compared with similar studies that have been done.

As Dr. Courcoulas points out, while the findings of the study are promising, they should be looked at with a degree of caution, until the results are compared with other studies and also a follow-up is done after a longer period of time. Also, the Joslin Diabetes Center Obesity Clinical Program’s medical director, Dr. Osama Hamdy, who did not take part in doing the research of the new study, stated that “people have to weigh the risks and benefits,” when considering having weight loss surgery done.

Is weight loss surgery better at combating type 2 diabetes than lifestyle intervention? The results of a recent study published in JAMA Surgery, in which the lead researcher was Dr. Courcoulas, seems to suggest that it is better. However, the study was a relatively small one, involving just 61 people, and further studies, comparisons with other studies, and a follow-up after a period of years still needs to be done before a conclusive answer can be reached.